Morning Awakening Research Articles

Sleep disorders among shift and day-working nurses in public and private sector hospitals of Peshawar

Objective: To determine the effects of shift working in relation to sleep disorder among nurses working in public and private sector hospitals of Peshawar, Pakistan. Methods: A cross-sectional study was conducted at Lady Reading Hospital and North West General Hospital Peshawar, Pakistan from May 2017 to August 2018. All nurses with at least 12 months of work experience and had been employed in the current shift for the last one month were consecutively enrolled. The Pittsburg Sleep Quality Index (PSQI) was utilized to collect data about sleep pattern. PSQI questions assessed following sleep pattern in the past four weeks; duration of sleep in hours/night, quality of sleep, trouble in sleep initiation, trouble in maintaining sleep, early morning awakening, use of sleep medications, and attention at work. The participant suffering from at least one complaint once or twice a week was considered positive for sleep disorder. Results: Of 227 subjects, sleep disorder was found in 170 (74.9%) nurses. A significantly higher sleep disorder was found among females (p-value <0.001), nurses working in public sector hospital (p-value <0.001), having dual job (p-value 0.008), and monthly rotational duty (p-value <0.001). Furthermore, walking at night (p-value 0.023), difficulty in day time concentration (p-value 0.005), and unsatisfied sleep quality (p-value 0.006) were the variables significantly higher in nurses with monthly rotational duty as compared to nurses with fixed day time duty. Conclusion: These findings of the research provided evidence that nurses employed in shifts particularly throughout nights are significantly prone to sleep disorders.

The association between plasma metabolites and sleep quality in the Southall and Brent Revisited (SABRE) Study: A cross-sectional analysis.

We examined the association between plasma metabolites and abnormal sleep patterns using data from the Southall and Brent REvisited (SABRE) cohort. Nuclear magnetic resonance spectroscopy provided 146 circulating plasma metabolites. Sleep questionnaires identified the presence or absence of: difficulty falling asleep, early morning waking, waking up tired, and snoring. Metabolites were compared between the sleep quality categories using the t test, and then filtered using a false discovery rate of 0.05. Generalised linear models with logit‐link assessed the associations between filtered metabolites and sleep phenotypes. Adjustment was made for important demographic and health‐related covariates. In all, 2,718 participants were included in the analysis. After correcting for multiple testing, three metabolites remained for difficulty falling asleep, 59 for snoring, and none for early morning waking and waking up tired. After adjusting for sex, age, ethnicity and years of education, 1 standard deviation increase in serum histidine and valine associated with lower odds of difficulty falling asleep by 0.89–0.90 (95% confidence intervals [CIs] 0.80–0.99). Branched‐chain and aromatic amino acids (odds ratios [ORs] 1.19–1.25, 95% CIs 1.09–1.36) were positively associated with snoring. Total cholesterol in low‐density lipoprotein (OR 0.90, 95% CI 0.83–0.97) and high‐density lipoprotein (OR 0.88, 95% CI 0.81–0.95) associated with lower odds of snoring. In the fully adjusted model, most associations persisted. To conclude, histidine and valine associated with lower odds of difficulty falling asleep, while docosahexaenoic acid and cholesterol in low‐density lipoprotein and high‐density lipoprotein subfractions associated with lower odds of snoring. Identified metabolites could provide guidance on the metabolic pathways associated with adverse sleep quality.

Number of Chronic Nighttime Insomnia Symptoms and Risk of Chronic Widespread Pain and Pain-Related Disability: The HUNT Study.

Study ObjectivesTo examine the association between the number of chronic nighttime insomnia symptoms and the risk of chronic widespread pain (CWP) and pain-related disability.MethodsA prospective study of 10,847 participants in the Norwegian HUNT Study without chronic musculoskeletal pain at baseline in 2006–2008. We used a modified Poisson regression model to estimate adjusted risk ratios (RRs) with a 95% confidence interval (CI) for CWP and pain-related disability at follow-up in 2017–2019 associated with insomnia and number of nighttime insomnia symptoms at baseline. Chronic insomnia was defined according to the current classification system and grouped into three categories based on the number of reported nighttime symptoms (ie, difficulty initiating sleep, trouble maintaining sleep and early morning awakenings).ResultsCompared to the reference group of people without insomnia, people with insomnia had RRs for CWP and pain-related disability of 1.64 (1.26–2.14) and 1.63 (1.37–1.94), respectively. When people with insomnia were categorized based on the number of nighttime symptoms, people who reported one, two, or three nighttime symptoms had RRs of CWP of 1.19 (95% CI 0.80–1.78), 1.78 (95 CI 1.13–2.80) and 3.08 (95% CI 1.93–4.92), respectively, compared to people without insomnia. The corresponding RRs for pain-related disability were 1.49 (95% CI 1.17–1.89), 1.46 (95% CI 2.04–2.05), and 2.46 (95% CI 1.76–3.42).ConclusionThese findings indicate that people with insomnia characterized by symptoms in all phases of the sleep period have a substantially increased risk of CWP and pain-related disability.

Insomnia Symptoms in Patients With Substance Use Disorders During Detoxification and Associated Clinical Features.

Background: Insomnia is highly prevalent in patients with substance use disorders (SUD), and it has been related to a worse course of addiction. Insomnia during detoxification in a hospital has not been adequately studied. This study aims to compare sociodemographic, clinical, and psychopathological characteristics of SUD patients undergoing a detoxification program, by comorbidity and insomnia symptoms.Methodology: We recruited 481 patients who received pharmacological and psychotherapeutic treatment for detoxification. They were evaluated through semi-structured interviews, standardized questionnaires, and a specific sleep log. A bivariate and multivariate analysis of the data was performed.Results: Insomnia was reported by 66.5% patients, with sleep-maintenance insomnia the most frequent issue, followed by early morning awakening and sleep-onset insomnia. Patients with alcohol use disorder and cannabis use disorder had higher prevalence of sleep-onset insomnia. Patients with cocaine and heroin use disorder had higher prevalence of sleep-maintenance insomnia. Independent factors that allowed the identification of insomnia symptoms included being female (OR: 3.43), polysubstance use (OR: 2.85), comorbid anxiety disorder (OR: 2.02), and prior admission for detoxification (OR: 1.22).Conclusions: Insomnia symptoms are very prevalent in patients admitted for detoxification. The diagnosis and therapeutic strategies for the insomnia symptoms should be improved, especially in women and in patients with greater addiction severity and with anxiety disorders.

Insomnia subtypes and clinical impairment in hospitalized children with autism spectrum disorder

Insomnia subtypes are not well understood in the most severely affected children with autism spectrum disorder. We examined length of hospital stay, autism severity, nonverbal intelligence quotient, and behavioral functioning across insomnia subtypes in 427 psychiatrically hospitalized children with autism spectrum disorder (mean age = 12.8 ± 3.4; 81.3% male). Per parent report, 60% (n = 257) of children had at least one type of insomnia. The distribution of subtypes was difficulty falling asleep (26.1%, n = 67), difficulty staying asleep (24.9%, n = 64), early morning awakening (4.3%, n = 11), and multiple insomnia symptoms (44.7%, n = 115). Difficulty staying asleep and early morning awakenings were associated with longer hospital stays. Early morning awakening was also associated with higher autism symptom severity. In general, children with difficulty staying asleep or multiple insomnia symptoms scored lower on adaptive behaviors (e.g. communication, self-care, socialization) and higher on maladaptive behaviors (e.g. irritability, hyperactivity, emotional reactivity, and emotional dysphoria). Difficulty staying asleep or having multiple insomnia symptoms appears to be most strongly related to impaired behavioral functioning. Conversely, early morning awakenings may be more closely tied with autism spectrum disorder itself. Further research is needed regarding insomnia subtypes at the severe end of the autism spectrum.

Difficulty in initiating sleep is associated with poor morning cardiovascular function

Insomnia is a risk factor for hypertension and cardiovascular events, and this association is strongest for sleep-onset insomnia. This study explored morning cardiovascular function in individuals with sleep-onset insomnia by analysing heart rate variability (HRV), blood pressure variability, and baroreflex sensitivity. Sleep quality of fifteen good sleepers and 13 individuals with sleep-onset insomnia was measured by overnight polysomnography, followed by continuous recordings of the participant's blood pressure and heart rate for 10 min immediately after they had woken up the following morning. After morning awakening (averaged time: 12.33 ± 10.48 min), a significantly reduced vagal tone assessed by HRV, including lower total power of HRV, lower high frequency of HRV, and elevated slopes of systolic as well as diastolic blood pressure in the morning with a blunted baroreflex sensitivity in the insomnia group were noted, compared to the control group. No differences in sympathetic-related activity were observed. The regulation of cardiovascular activity by the parasympathetic nervous system plays an important role in sleep-onset insomnia. Weak vagal modulation and blunted baroreflex sensitivity were evident in this insomnia subtype, which indicates that difficulty in initiating sleep can independently affect morning cardiovascular function.

The association between sleep pathology and depression: A cross-sectional study among adults in Greece

A cross-sectional population based study was conducted in order to evaluate the potential association of sleep characteristics with depression using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants aged between 19 and 86 years old were enrolled in our study. Depression symptoms were assessed using the Beck Depression Inventory. Participants self-reported their daily sleep habits and filled in the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of depression was 28.4%. Depression symptoms were more prominent among minority groups. Subjects with depression reported shorter sleep duration and had reduced sleep efficiency. In patients with depression mean sleep duration was reduced by 23 min and mean sleep efficiency by 4%. Patients with depression were at higher risk of insomnia, poor sleep quality and obstructive sleep apnea, but not of excessive daytime sleepiness. Concerning insomnia subtypes, depression was associated with difficulties maintaining sleep and early morning awakening, but not problems initiating sleep. Sleep disturbances are highly prevalent in depression and our findings support early pharmacological or cognitive behavioral interventions in order to address this key depression-associated symptom. Only addressing problems initiating sleep might not be sufficient in depression.

Applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems.

This discussion article considers applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems among infants, children, and youth who are typically developing and have neurodevelopmental disabilities. Measurement has concentrated on designing practitioner-implemented methods and improving fidelity of data recording through sleep-monitoring instrumentation. The emphasis of assessment is identifying antecedent and consequence variables that promote sleep and evoke and maintain sleep-related problems. Treatment research has evaluated several effective interventions for problems such as delayed sleep-onset, night and early morning waking, bedtime resistance, and unwanted co-sleeping. Early and contemporary applied behavior analysis research is reviewed relative to function-based treatment formulation, intervention integrity, social validity, and research-to-practice translation.

The influence of age, gender and the FKBP5 genotype on subjective health complaints in the Norwegian working population

ObjectiveIn the present study we examined the potential association between age, gender, the genetic variant FKBP5 rs9470080 and subjective health complaints. MethodsThe data were collected through a three-wave nationally representative survey of 1060 Norwegian employees drawn from the Norwegian Central Employee Register by Statistics Norway. The follow-up period was six months. Subjective health complaints were scored by eight items reflecting; headache, neck pain, mid- and low back pain, stomach cramps or intestinal discomfort, problems with sleep onset or maintenance and early morning awakening. Genotyping with regard to FKBP5 rs9470080, previously linked to cortisol sensitivity, was carried out using Taqman assay. ResultsThe baseline data showed that in women, levels of subjective health complaints were highest among those above 50 years of age. Moreover, in women the rs9470080 CC variant at baseline was associated with higher levels of subjective health complaints. However, the effect size was not large, and no relationships were demonstrated between age or genotype and subjective health complaints in men. Also, the study variables were not related to any changes in the levels of subjective health complaints during the follow-up period. ConclusionWe conclude that our biology such as age and sex, but also single genetic variants found in non-sex chromosomes, may be important in understanding the mechanisms underlying subjective health complaints in the general working population.

40.2 SLEEP AND AUTISM SPECTRUM DISORDER

Children with autism spectrum disorder (ASD) frequently experience sleep problems. The most prominent sleep problem is insomnia, with difficulty falling asleep, difficulty maintaining sleep, and early morning awakenings. Insomnia is one of the most common reasons why parents seek medical intervention in children with ASD, and may exacerbate daytime symptoms, as well as contribute to parental stress. The objective of this presentation is to educate the attendees about the insomnia often experienced by youth with ASD and the subsequent impact on daytime functioning. Potential etiologies of the insomnia will be discussed as well as treatments.

55 Profiles of Sleep Problems among Young Children with Autism Spectrum Disorders

Abstract Background Sleep problems are more common and severe among children with autism spectrum disorder (ASD) compared to their typically developing peers. The goal of this study was to characterize sleep problems profiles and their clinical correlates, based on a five-factor model of the Children’s Sleep Habits Questionnaire (CSHQ) among preschool children with ASD. Objectives (1) To describe empirically-derived patterns (i.e., latent profiles) of sleep problems among young children with ASD; and (2) To examine relations between family cumulative risk and emotional-behavioral dysregulation symptoms and sleep profile membership. Design/Methods The study included 318 three-to-five year old children (M= 49.45 months; SD = 5.77). Latent profile analysis was used to identify and describe profiles of sleep problems. Sleep problems were assessed using a previously established CSHQ five-factor model: (1) Bedtime Routine; (2) Sleep Onset &amp; Duration; (3) Night Waking; (4) Morning Waking; and (5) Sleep Disordered Breathing, with higher scores indicating greater problems. We assess whether profile membership was associated with dysregulation difficulties (CBCL 1.5-5) and family cumulative risk index (CRI; constructed based on socioeconomic status, maternal distress, family functioning, and other related factors) using a three-step method (Vermunt &amp; Magidson, 2013). Results A five-profile model of children’s sleep problems showed the best fit (Figure 1). Profile 1, Nighttime Sleep Problems (28%), consisted of children with scores around the sample mean, except relatively lower scores on Morning Waking. Profile 2, Severe Sleep Problems (25%), consisted of children with relatively high scores across all sleep problems. Profile 3, Low Sleep Problems (18%), included children with the lowest levels of all sleep problems. Profile 4, Moderate Sleep Problems (17%), included children with all sleep problem levels near the sample mean. Profile 5, Morning Waking Problems (12%), consisted of children with low scores on Bedtime Routine problems but pronounced Morning Waking problems. Dysregulation difficulties (Wald = 13.90; p = .001) and family CRI (Wald = 13.27; p =.001) emerged as significant predictors of profile membership. Higher CRI was associated with higher odds of membership in Profile 2 (Severe Sleep Problems), and lower scores for dysregulation difficulties were associated with higher odds of membership in Profile 3 (Low Sleep Problems). Conclusion Children with ASD present distinct profiles of sleep problems that differ, not only by overall severity, but also by relative severity across types of sleep problems. Children’s dysregulation and family risk should be considered in examining children’s sleep.

Sleep disturbance in adults with chronic pruritic dermatoses is associated with increased C-reactive protein levels

Pruritus is a common symptom that can significantly reduce quality of life through sleep disruption. To examine features of disturbed sleep in patients with chronic pruritic dermatoses and test the hypothesis that systemic inflammation may serve as a biomarker for impaired sleep in these patients. Cross-sectional analysis of the National Health and Nutrition Examination Survey investigating systemic inflammation using C-reactive protein (CRP) levels. Logistic regression was used to compare patients with and without sleep disturbances, adjusting for demographics (model 1) and medical comorbidities (model 2). Chronic pruritic dermatoses were associated with multiple sleep disturbances, including nighttime awakenings (model 1: odds ratio [OR], 1.646; 95% confidence interval [CI], 1.031-2.627; model 2: OR, 1.329; 95% CI, 0.888-1.989) and early morning awakening (model 1: OR, 1.669, 95% CI, 1.118-2.493; model 2: OR, 1.582; 95% CI, 1.008-2.481). Mean CRP levels were 52.8% higher among patients with pruritic dermatoses reporting trouble sleeping compared with those who did not (0.663 vs 0.434mg/dL; P=.034). Trouble sleeping was also positively correlated with CRP levels (β=0.142, P=.025). Potential recall bias among participants. In addition to confirming sleep disturbances with pruritic dermatoses, we found these disturbances are more likely to present with elevated CRP levels. Clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy skin conditions.

Sleep medications and sleep disturbances across middle aged pre- or peri-menopausal women of different race and ethnicities: A SWAN pharmacoepidemiology cohort study.

Sleep disturbances are common, particularly in middle aged women. Prescription medications for this indication are increasingly used, despite uncertain safety. This study assessed prescription medication use for sleep among a cohort of women with and without sleep disturbances. We examined reports of sleep disturbance and sleep medication use among pre- and early peri-menopausal womenassessed annually or biennially since 1996. Women self-reported medications at visits, and we identified medications that have been used primarily for sleep disturbances. They reported on difficulties falling and staying asleep, and early morning wakening. Sleep medication use across 20 years of follow-up was examined for all women and by race/ethnicity. Women who reported data for both sleep disturbance and sleep medication use were included in the analyses.. Among participants in a cohort of 3302 women who were enrolled prior to their menopause transition, 3082 women were included in the analytic sample and 2531 (82%) reported sleep disturbances. They were more likely to endorse higher anxiety and pain scores and more comorbid conditions than women without sleep disturbances. Baseline characteristics were similar among women who did and did not use sleep medications. Among women reporting a sleep disturbance at baseline, 2.5% reported sleep medication use, increasing to 8% over 20 years. However, the proportion of women reporting sleep medication use who did not report a sleep disturbance remained low, approximately 1% to 2% over the entire follow-up. Increases in sleep medication use was observed across women of all race/ethnicities. The use of sleep medications among women reporting sleep disturbance grew over the last 20 years. Growth was observed across women of all race/ethnicities.

Koroner Arter Baypas Operasyonu Sonrası Uyku Bozukluğu

Introduction: In general, after coronary artery bypass operation, 39% to 69% of patients experience insomnia, poor sleep quality, and lack of sleep continuity (frequent awakening, difficult sleep, restless sleep, and early morning awakening). The aim of this study was to investigate the sleep quality of patients on the preoperative 1st day, postoperative 3rd day, postoperative 7th day, and postoperative 30th day of a coronary artery bypass operation. Patients and Methods: Ninety-nine patients who underwent elective coronary bypass operation in our clinic between January 2017 and January 2018 were included in this study. The patients were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire on the preoperative 1st day, postoperative 3rd day, postoperative 7th day, and postoperative 30th day. Results: The mean age of total patients was 61.5 ± 11.4 years (range: 35-80); 67 were male and 22 were female. According to the results of the PSQI survey conducted on patients, there is a statistically significant increase in sleep quality on the postoperative 3rd day in comparison with the results of the preoperative 1st day evaluation. According to the postoperative 3rd day evaluation, there is a statistically significant decrease in sleep quality compared with the postoperative 7th and 30th days. Also, the PSQI scores of the postoperative period have a statistically significant correlation with age (p= 0.002, p= 0.004, p= 0.009). Conclusion: Although sleep disturbance has a significant impact on the physical and emotional adaptation and recovery after coronary artery bypass operation, the number of studies conducted on this subject is quite low.

INSOMNIA IN JAIL INMATES: A STUDY FROM THE SUB HIMALAYAN REGION OF NORTH INDIA.

Introduction: Insomnia has been defined as having difficulty in initiating or maintaining sleep, or experiencing early morning awakenings, with resultant daytime impairment.1,2,3 Insomnia is a serious condition that affects over 60% of the prison population and has been associated with aggression, anger, impulsivity, suicidality, and increased prison health care use. 4 Hence management of insomnia in jail inmates become important. Benzodiazepines are commonly prescribed medications for insomnia.&#x0D; According to the FDA, fast-onset, short acting benzodiazepines should not be prescribed for more than five consecutive weeks, to avoid the risk of dependency. Though in reality, they are commonly used for longer durations which can lead to complications.5&#x0D; Mirtazapine is an antidepressant drug with US Food and Drug Administration approval for the management of major depressive disorder. At lower doses mirtazapine is often used for management of insomnia.&#x0D; Methods: This study consisted of a sample of 40 jail inmates who were on benzodiazepine for insomnia. Benzodiazepine was cross tapered with mirtazapine. Insomnia was studied using daily sleep diary which was assessed weekly.&#x0D; Results: The study identified that mirtazapine at lower dose can be used for long term management of insomnia.&#x0D; Discussion: In long term management of insomnia not only medications but sleep hygiene, regular exercise and education regarding the effects of long term use of sedatives should be included as is done in general population.&#x0D; Keywords: jail inmates, insomnia, mirtazapine, benzodiazepine.

Self-reported difficulty initiating sleep and early morning awakenings are associated with nocturnal diastolic non-dipping in older white Swedish men

Chronically blunted nocturnal blood pressure (BP) dipping has been shown to increase the future risk of cardiovascular diseases. In the present cross-sectional study, we investigated whether self-reported insomnia symptoms were associated with an altered 24-h BP profile and blunted nocturnal BP dipping (night-to-day BP ratio > 0.90) in older men. For the analysis, we used 24-h ambulatory blood pressure data and reports of insomnia symptoms (difficulty initiating sleep, DIS; and early morning awakenings, EMA) from 995 Swedish men (mean age: 71 years). Compared to men without DIS, those reporting DIS (10% of the cohort) had a higher odds ratio of diastolic non-dipping (1.85 [1.15, 2.98], P = 0.011). Similarly, men who reported EMA (19% of the cohort) had a higher odds ratio of diastolic non-dipping than those without EMA (1.57 [1.09, 2.26], P = 0.015). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+ 1.4 mmHg, P = 0.042), no other statistically significant differences in BP and heart rate were found between men with and those without insomnia symptoms. Our findings suggest that older men reporting difficulty initiating sleep or early morning awakenings may have a higher risk of nocturnal diastolic non-dipping. Our findings must be replicated in larger cohorts that also include women.

Sleep Difficulties and Cognition for 10 Years in a National Sample of U.S. Older Adults.

Background and ObjectivesSleep difficulties are common among older adults and are associated with cognitive decline. We used data from a large, nationally representative longitudinal survey of adults aged older than 50 in the United States to examine the relationship between specific sleep difficulties and cognitive function over time.Research Design and MethodsLongitudinal data from the 2004–2014 waves of the Health and Retirement Study were used in the current study. We examined sleep difficulties and cognitive function within participants and across time (n = 16 201). Sleep difficulty measures included difficulty initiating sleep, nocturnal awakenings, early morning awakenings, and waking up feeling rested from rarely/never (1) to most nights (3). The modified Telephone Interview for Cognitive Status was used to measure cognitive function. Generalized linear mixed models were used with time-varying covariates to examine the relationship between sleep difficulties and cognitive function over time.ResultsIn covariate-adjusted models, compared to “never” reporting sleep difficulty, difficulty initiating sleep “most nights” was associated with worse cognitive function over time (Year 2014: b = −0.40, 95% CI: −0.63 to −0.16, p < .01) as was difficulty waking up too early “most nights” (Year 2014: b = −0.31, 95% CI: −0.56 to −0.07, p < .05). In covariate-adjusted analyses, compared to “never” reporting waking up feeling rested, cognitive function was higher among those who reported waking up feeling rested “some nights” (Year 2010: b = 0.21, 95% CI: 0.02 to 0.40, p < .05).Discussion and ImplicationsOur findings highlight an association between early morning awakenings and worse cognitive function, but also an association between waking up feeling rested and better cognitive function over time.

Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study.

The aim of this study was to investigate the prevalence of sleep problems, depression and anxiety symptoms among conscripted frontline nurses fighting coronavirus disease 2019 (COVID-19) in Wuhan.This study was a cross-sectional study conducted with 100 frontline nurses. Sleep quality, depression, and anxiety symptoms were measured using the Pittsburgh sleep quality index (PSQI), the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively.Mean sleep duration was 5.71 hours (SD = 1.09) and mean sleep latency was 33.49 minutes (SD = 28.87). A total of 76%, 81%, 45%, and 19% reported difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) or early morning awakening (EMA), nightmares and using hypnotics respectively. Among 100 participants in this study, 60 (60%) had poor sleep quality, 46 (46%) suffered depression symptoms and 40 (40%) reported anxiety symptoms. Sleep quality (OR = 3.16, 95% CI: 1.17–8.52) and anxiety symptoms (OR = 8.07, 95% CI: 2.92–22.33) were significantly associated with depression symptoms. Depression symptoms (OR = 7.92, 95% CI: 2.89–21.73) were related to anxiety symptoms. Similarly, depression symptoms (OR = 3.24, 95% CI: 1.19–8.79) were associated with poor sleep quality.Sleep disturbance, depression, and anxiety symptoms are very common among frontline nurses who treating patients with COVID-19 in Wuhan, China. Comprehensive measures that involve psychosocial and personal behaviors should be implemented to improve sleep quality and prevent depression and anxiety symptoms.

Smokers with insomnia symptoms are less likely to stop smoking

ObjectivesSmoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances. MethodsA questionnaire was sent to randomly selected men and women in Northern Europe in 1999–2001 (RHINE II) and was followed up by a questionnaire in 2010–2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening ≥3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR). ResultsSubjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4–0.8), difficulty maintaining sleep (0.7; 0.5–0.9), early morning awakening (0.6; 0.4–0.8), any insomnia symptom (0.6; 0.5–0.8) or excessive daytime sleepiness (0.7; 0.5–0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2–2.3). ConclusionsInsomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.

Sleep in New Zealand children aged 7-9: associations with ethnicity, socioeconomic status, and achievement in reading and mathematics.

The aims were (1) to investigate differences by ethnicity and socioeconomic status (SES) in objective measures of sleep in children aged 7-9 years and (2) determine whether measures of sleep predict child achievement in reading or mathematics after controlling for ethnicity and SES. Four groups of parent-child dyads were recruited: Māori, low-SES schools (n = 18); Māori, high-SES schools (n = 17); New Zealand European, low-SES schools (n = 18); New Zealand European, high-SES schools (n = 17). Child sleep was measured by actigraphy. Parents and teachers reported child daytime sleepiness and behavior, and children completed a self-report of anxiety symptoms. Teachers also reported on child achievement in reading and mathematics. Children from low-SES schools went to bed later on school nights (F[1,68] = 12.150, P = .001) and woke later (F[1,68] = 15.978, P < .001) than children from high-SES schools but had similar sleep duration. There were no differences related to ethnicity. Children from low-SES schools were almost 3 times more likely to be below national standards for mathematics. Children not meeting academic standards in mathematics had a later sleep start time, lower sleep period efficiency, and a decreased total sleep time. However, when SES and sleep period efficiency were modeled together neither were found to significantly influence achievement in mathematics. In this study, SES influenced sleep timing but not the quality and quantity of sleep in 7- to 9-year-old children, and a significant independent effect of sleep efficiency on learning could not be demonstrated.